Download Horie Shigeo - World Cancer Congress

HOW CAN WE MOBILISE ACTION TO
REALISE UHC IN ASIA?
Clinical evaluation of UHC for
cancer
Shigeo Horie, M.D., Ph. D.
Department of Urology
Juntendo University Graduate School of Medicine
3 objectives of UHC
• Equity in access to health services
• those who need the services should get them, not only
those who can pay for them
• Quality of health services
• Being good enough to improve the health of those
receiving services
• Financial-risk protection
• ensuring that the cost of using care does not put
people at risk of financial hardship.
How UHC for cancer can be
achieved in Asia
• UHC is conceptually appealing but its
application will vary from one country to
another given the diversity of country levels
of economic development, health system
resources and epidemiological challenges.
• It is important to identify ways of
measuring UHC across countries that are
comparable but adaptable to local contexts.
MEASUREMENT AND MONITORING OF UNIVERSAL HEALTH COVERAGE
WHO summary report 2013
Breast cancer survival is a key indicator
for UHC in cancer control
• How countries are covering prevention,
care, and treatment of cancers.
• a focus on women
• the need for well-trained health workers and
functioning infrastructure
• including laboratory capacity, an adequate
stock of medicines, and radiation equipment.
Fundamental barriers to UHC of
cancer care
• Primary prevention Eligibility
• financial barriers
• Survivorship
Accessibility
• Palliation
• linkage barriers between
services with referral
networks
screening
diagnosis
treatment
treatment
palliation
rehabilitation
UHC and clinical guidelines
• Clinical guidelines should be stratified
according to the resource availability.
• Resource-stratified guidelines can be
utilized for bench-marking.
Treatment of clinically localized prostate cancer
according to level of health-care resources
Health care
resource
category
Basic level
Limited
level
Enhanced
level
Maximum
level
General
Treatment
Patients
education
Surgical castration
Radical prostatectomy
Infrastructure to
diagnosis and
treatment
Curative –aim therapy
PADT
Multidisciplinary
team
management
Survivorship
programmes
Laparoscopic surgery
Radiation w/wo hormone
PADT
Active surveillance
PSA monitoring
Side-effect management
Access to clinical trials
Lancet Oncol 2013；14:e524-34
ACS #6a
ACS #6b
[CONFIDENTIAL: Working Draft 150622]
15
Kaplan–Meier estimates of OS in Swedish patients diagnosed with
mRCC by year of diagnosis
2012
2002
M Lindskog et al. ASCO-GU 2015
More access to drugs, longer life span
• International mRCC Database Consortium
database
• Overall survival of patients who received 1, 2, or
3+ lines of target therapy were 14.9, 21.0, and
39.2 months, respectively
• On multivariable analysis, 2 lines and 3+ lines of
therapy were each associated with better OS
(HR=0.738 and 0.626, P<0.0001).
British Journal of Cancer (2014) 110, 1917–1922.
Sustainable UHC
Lancet oncology 2015
PD-1 ab costs $1.9 million/month
Precision Medicine in Cancer treatment
Precision medicine in oncology is focused on identifying
which therapies will be most beneficial for each patient
based on genetic characterization of their cancer.
20
Evaluate predictive biomarkers by
“Liquid biopsy”
Circulating tumor cells
Cell-free DNA
Exosome
Hegemann M et al. BJU Int 2015
exosomal protein, miRNA
21
AR-V7 Status matters for “precision” drug choice
AR-V7 (+)
Docetaxel (generic)
AR-V7 (-)
AR target medicine
Antonarakis ES, et al. ;N Engl J Med. 2014 Sep 3 (e-pub)
Achieving UHC in Cancer treatment
• Increase survival
• Maintain quality of life and Reduce
the disease burden
Shared decision making
• What matters most?
• choice
• option
• preference
• value
–責任
Localized
prostate cancer
surgery
UHC for cancer in Asia
• Diversity
• Resource stratification
• Public awareness, prevention
• Evaluation and appraisal
• Precision Medicine
• Select appropriate population
• Shared decision making
• Respect value